尿道球部闭合性损伤患者内镜下会师术后并发尿道狭窄的危险因素分析  

Risk factor analysis of urethral stricture after endoscopic realignment for patients with closed bulbar urethralinjury

作　　者：李金雨[1] 汤仕杰 于忠英[1] 赵力 郁毅刚[3] 朱显钟 林伟鹏 Li Jinyu;Tang Shjie;Yu Zhongying;Zhao Li;Yu Yigang;Zhu Xianzhong;Lin Weipeng(Department of Urology,909th Hospital of Joint Logistic Support of PLA,Affiliated Dongnan Hospital of Xiamen University,Zhangzhou 363000,China;Department of Urology,General Hospital of Xizang Military Region,Lhasa 850000,China;Department of Emergency,909th Hospital of Joint Logistic Support of PLA,Affiliated Dongnan Hospital of Xiamen University,Zhangzhou 363000,China)

机构地区：[1]中国人民解放军联勤保障部队第九○九医院,厦门大学附属东南医院泌尿外科,漳州363000 [2]西藏军区总医院泌尿科,拉萨850000 [3]中国人民解放军联勤保障部队第九○九医院,厦门大学附属东南医院急诊科,漳州363000

出　　处：《中华创伤杂志》2024年第4期367-372,共6页Chinese Journal of Trauma

基　　金：福建省自然科学基金(2023J011834)。

摘　　要：目的:探讨尿道球部闭合性损伤患者内镜下会师术(ER)后并发尿道狭窄的危险因素。方法:采用回顾性队列研究分析2015年6月至2021年6月中国人民解放军联勤保障部队第九〇九医院收治的126例尿道球部闭合性损伤患者的临床资料,年龄20~69岁[(45.1±12.5)岁]。根据ER术后是否并发尿道狭窄,分为狭窄组(43例)和非狭窄组(83例)。比较两组年龄、致伤原因、阴囊血肿、尿道损伤程度、受伤至手术时间、术前导尿次数、术前是否行膀胱造瘘、内镜会师术方式、尿道镜探查时长、术后导尿管是否牵拉、术后中段尿培养结果等情况。采用单因素分析评估上述指标与ER术后并发尿道狭窄的相关性。采用多因素Logistic回归分析确定ER术后并发尿道狭窄的独立危险因素。结果:单因素分析结果显示,尿道损伤程度、术前导尿次数、术前是否行膀胱造瘘、尿道镜探查时长、术后中段尿培养结果阳性与ER术后尿道狭窄有一定的相关性( P<0.05或0.01)。多因素Logistic回归分析结果表明,尿道完全断裂( OR=4.54,95% CI 1.74,11.86, P<0.01)、术前导尿次数≥3次( OR=2.72,95% CI 1.41,5.25, P<0.01)、尿道镜探查时长≥35 min( OR=1.06,95% CI 1.03,1.09, P<0.01)、术后中段尿培养结果阳性( OR=42.99,95% CI 5.91,312.92, P<0.01)与ER术后并发尿道狭窄显著相关。 结论:尿道完全断裂、术前导尿次数≥3次、尿道镜探查时长≥35 min、术后中段尿培养结果阳性是尿道球部闭合性损伤患者ER术后并发尿道狭窄的独立危险因素。Objective To investigate the risk factors of urethral stricture after endoscopic realignment(ER)for patients with closed bulbar urethral injury.Methods A retrospective cohort study was conducted to analyze the clinical data of 126 patients with closed bulbar urethral injury who were admitted to 909th Hospital of Joint Logistic Support of PLA from June 2015 to June 2021,aged 20-69 years(45.1±12.5)yearsl.The patients were divided into stricture group(n=43)and non-stricture group(n=83)according to whether urethral stricture occurred after ER.Data were compared between the two groups including age,cause of injury,scrotal hematoma,degree of urethral injury,time from injury to operation,times of preoperative catheterization,performance of cystostomy or not before operation,method of endoscopic realignment,length of urethroscopy,traction on the catheter or not after operation,results of postoperative midstream urine culture,etc.Univariate analysis was used to assess the correlation between the aforementioned indexes and urethral stricture after ER.Multivariate Logistic regression analysis was applied to determine the independent risk factors of urethral stricture after ER.Results Univariate analysis showed that there was certain correlation of degree of urethral injury,times of preoperative catheterization,performance of cystostomy or not before operation,length of urethroscopy,and positive results of postoperative midstream urine culture with urethral stricture after ER(P<0.05 or 0.01).Multivariate Logistic regression analysis showed that complete urethral rupture(OR=4.54,95%CI 1.74,11.86,P<0.01),preoperative catheterization≥3 times(OR=2.72,95%CI 1.41,5.25,P<0.01),length of urethroscopy≥35 minutes(0R=1.06,95%CI 1.03,1.09,P<0.01)and positive results of postoperative midstream urine culture(0R=42.99,95%CI 5.91,312.92,P<0.01)were significantly correlated with urethral stricture after ER.Conclusion Complete urethral rupture,preoperative catheterization≥3 times,length of urethroscopy≥35 minutes and positive results

关 键 词：尿道狭窄 内窥镜 外科手术 微创性 危险因素 

分 类 号：R699.6[医药卫生—泌尿科学]